Comparison of functional fibrinogen assessment using thromboelastography with the standard von Clauss method

Fluger, Ivo; Maderová, Kateřina; Šimek, Martin; Zapletalová, Jana; Lonský, Vladimír

doi:10.5507/bp.2011.035

Cited by 20 publications

(17 citation statements)

References 5 publications

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“…γTrp395(369)Leu was supposed to be associated with defective fibrin polymerization since γTrp395(369) was in pocket a, which is localized to residues 337 to 379 of mature γ chain [29]. Moderate correlations between Fg:C and MA or MA-CFF have been widely identified [8][9][10], as well as in normal individuals in the current study. However, no such correlation was found in patients with CD, which may be due to the cause of such disease being quality deficiency instead of quantity deficiency.…”

Section: Discussionmentioning

confidence: 58%

“…Functional fibrinogen TEG (FF-TEG), which eliminates the contribution of platelets to clot strength, is special to evaluate all aspects of Fg function reflected by maximum amplitude (MA-CFF). Moderate correlations between fibrinogen level measured by Clauss assay (Fg:C) and MA measured by kaolin activated TEG or MA-CFF measured by FF-TEG have been identified both in healthy volunteers and in patients operated for ischemic heart disease without known coagulopathy or hepatopathy [8][9][10]. Mutant fibrinogen purified from the plasma of dysfibrinogenemia patients were shown to affect the signal generation of TEG [11].…”

Section: Introductionmentioning

confidence: 96%

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Clinical features and molecular basis of 102 Chinese patients with congenital dysfibrinogenemia

Zhou

Ding

Chen

et al. 2015

Blood Cells, Molecules, and Diseases

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 96%

Clinical features and molecular basis of 102 Chinese patients with congenital dysfibrinogenemia

Zhou

Ding

Chen

et al. 2015

Blood Cells, Molecules, and Diseases

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“…The addition of lyophilized tissue factor including the platelet inhibitor abciximab, a glycoprotein (GP) IIb/IIIa receptor blocker in the TEG functional fibrinogen (FF) test, eliminates the influence of platelets on clot strength, thus assessing only the contribution of fibrin to MA. 35,39,40 The FF test has been found to strongly correlate with von Clauss fibrinogen levels (R 2 = 0.87) and clot strength (R 2 = 0.80) in trauma patients. 39 The TEM FIBTEM assay is an extrinsically activated test with the addition of cytochalasin D, which blocks the reorganization of the platelet cytoskeleton.…”

Section: Clot Strengthmentioning

confidence: 97%

Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Schöchl

Voelckel

Grassetto

et al. 2013

Journal of Trauma and Acute Care Surgery

101

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E xsanguination is responsible for 30% to 40% of trauma-related deaths. 1,2 Most of these fatalities occur in the prehospital setting. According to standard coagulation tests (SCTs), one quarter to one third of trauma patients present with coagulopathy on admission to the emergency department. 3Y5 The presence of coagulopathy increases the risk for poor outcomes, thus resulting in threefold to fourfold higher mortality rates. 3,5 Coagulopathic patients are at risk of exsanguination. It is assumed that up to 20% of these fatalities are potentially preventable by early hemostatic intervention. 6 Therefore, timely and reliable identification of the underlying cause of bleeding is paramount to improve survival.Despite remarkable advances in knowledge, the etiology of trauma-induced coagulopathy (TIC) is still not fully understood. Recent concepts suggest an ''endogenous'' TIC primarily driven by shock-associated hypoperfusion in combination with tissue trauma, which activates the protein C pathway, resulting in anticoagulation, hypofibrinogenemia, hyperfibrinolysis (HF), and platelet dysfunction. 7,8 In addition, ''exogenous'' factors such as consumption of coagulation proteins, in particular fibrinogen, and dilution of the remaining coagulation factors, accompanied by other potentiating effects, such as acidosis, hypothermia, and electrolyte disturbance, further contribute to TIC. 9 Importantly, TIC is not uniform but varies with pattern of injury and in type during the course of treatment, underscoring the potential importance of point-of-care (POC) testing that can rapidly provide information on an actual individual patient's coagulation status. 10 Conventional plasma-based coagulation testing, such as prothrombin time (PT) or international normalized ratio (INR), and activated partial thromboplastin time (aPTT) fail to fully assess the clotting process. SCTs were designed to evaluate anticoagulation therapy rather than coagulopathy in major trauma. 11 In fact, none of the conventional coagulation tests was developed to predict bleeding or to guide coagulation in the surgical setting. 11Y14 Moreover, a substantial amount of precious time transpires before the results of standard coagulation assessments become available, with a median turnaround time for these tests to be completed at a central laboratory ranging from 78 minutes to 88 minutes. 15,16 Viscoelastic tests (VETs), most commonly thrombelastography (TEG, Haemoscope-Haemonetics, Niles, IL) and rotational thromboelastometry (TEM, Tem Systems Inc., Durham, NC), provide a valuable alternative or an adjunct to SCT in the setting of bleeding in the emergency department. VETs yield rapid, POC assessment of whole-blood coagulation in a variety of conditions in which conventional testing may not be sensitive. 12,15,17,18 Unlike SCT, VETs provide a rapid and dynamic bedside assessment of the initiation and kinetics of clot formation, maximum clot firmness (MCF), and clot breakdown. 12,17,18 VETs can characterize the range of acute coagulopathies present in patient...

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“…The first, functional fibrinogen maximal amplitude (FF MA) is the maximal clot strength due to the polymerization of fibrin alone. The second, functional fibrinogen level (FLEV) is calculated by analytical software through a transformation of the FF MA to approximate the concentration of ‘functional’ fibrinogen contained in the sample (16). This crucial differentiation between platelet and fibrin contributions to clot strength can assist in tailoring both early resuscitation and later thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

Fibrinogen and platelet contributions to clot formation

Kornblith

Kutcher²,

Redick³

et al. 2014

Journal of Trauma and Acute Care Surgery

115

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BACKGROUND Thromboelastography (TEG) is used to diagnose perturbations in clot formation and lysis that are characteristic of acute traumatic coagulopathy (ATC). With novel functional fibrinogen (FF) TEG, fibrin- and platelet-based contributions to clot formation can be elucidated to tailor resuscitation and thromboprophylaxis. We sought to describe the longitudinal contributions of fibrinogen and platelets to clot strength after injury, hypothesizing that low levels of functional fibrinogen and a low contribution of fibrinogen to clot strength on admission would be associated with coagulopathy, increased transfusion requirements, and worse outcomes. METHODS 603 longitudinal plasma samples were prospectively collected from 251 critically-injured patients at a single Level 1 Trauma Center from 0–120h. TEG maximal amplitude (MA), FF MA, FF levels (FLEV), von Clauss fibrinogen, and standard coagulation measures were performed in parallel. Percentage contributions of FF (%MAFF) and platelets (%MAplatelets) were calculated as each MA divided by overall kaolin TEG MA. RESULTS Coagulopathic patients (INR>=1.3) had significantly lower admission %MAFF than non-coagulopathic patients (24.7% vs. 31.2%, p<0.05). Patients requiring plasma transfusion had a significantly lower admission %MAFF (26.6% vs. 30.6%, p<0.05). Higher admission %MAFF was predictive of reduced mortality (HR 0.815, p<0.001). %MAplatelets was higher than %MAFF at all time points, decreased over time, and stabilized at 72 hours (69.4% at 0h, 56.2% at 72h). In contrast, %MAFF increased over time and stabilized at 72 hours (30.6% at 0h, 43.8% at 72). CONCLUSION FF TEG affords differentiation of fibrin- versus platelet-based clot dynamics. Coagulopathy and plasma transfusion were associated with a lower %MAFF. Despite this importance of fibrinogen, platelets had a greater contribution to clot strength at all time points after injury. This suggests that attention to these relative contributions should guide resuscitation and thromboprophylaxis, and that antiplatelet therapy may be of under-recognized importance to thromboprophylaxis after trauma. LEVEL OF EVIDENCE Level IV; prognostic

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Comparison of functional fibrinogen assessment using thromboelastography with the standard von Clauss method

Cited by 20 publications

References 5 publications

Clinical features and molecular basis of 102 Chinese patients with congenital dysfibrinogenemia

Clinical features and molecular basis of 102 Chinese patients with congenital dysfibrinogenemia

Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Fibrinogen and platelet contributions to clot formation

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